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Objective To construct a risk assessment scale for postoperative delirium(POD)in elderly patients undergoing hip and knee joint replacement and evaluate the effect.Methods A total of 474 elderly patients undergoing hip and knee arthroplasty from March 2021 to May 2022 were collected as the training set,and a total of 153 the homogeneous patients from January 2022 to May 2022 were collected as the validation set.The patients were divided into two groups based on whether or not POD occurred:non-POD group and POD group.Risk factors of POD in the training set were analyzed by univariate analysis and multifactorial logistic regression.The consistency of the model was evaluated by Homser-Lemeshow goodness of fit test.The postoperative delirium risk assessment scale was established after the selected variables as-signed value according to OR value,and the predictive efficacy of the scale was evaluated by receiver oper-ating characteristic(ROC)curve.The patients in the training set and the validation set were divided into two groups according to the cut-off value:high-risk and low-risk.The incidence rate of POD with different risk stratification was calculated and the applicability of the risk assessment scale was evaluated.Results Fifty-eight patients(12.2%)with POD in the training set,and nineteen patients(12.4%)with POD in the validation set.Multifactor logistic regression showed that age≥85 years,ASA physical status Ⅲ or Ⅳ,the mini-mental state examination(MMSE)score≤24 points,preoperative sleep disorder,comorbid neu-rological disorders,use of general anesthesia,and non-use of dexmedetomidine were independent risk factors of POD.The POD risk assessment scale was then published based the seven risk factors.The ROC curve showed that the area under the curve(AUC)for this scale to predict the risk of POD was 0.956(95%CI 0.937-0.975),and the risk stratification was performed with a cut-off value of 44.5 points,which divided the patients into low-risk and high-risk.Compared with low-risk,the incidence rate of POD in high-risk patients group was significantly increased(P＜0.001).Conclusion A risk assessment scale based on the seven risk factors:age≥85 years,ASA physical status Ⅲ or Ⅳ,MMSE score≤24 points,preoperative sleep disorder,combined neurological disease,use of general anesthetic modality,and non-use of dexmedetomidine,can effectively identify elderly patients undergoing hip and knee replacement who are at high risk of developing POD.
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Resumen Objetivo: Este trabajo presenta los resultados preliminares de una encuesta realizada a psicólogos(as), para conocer las herramientas de evaluación que utilizan en el ámbito jurídico en el contexto local. Se realiza un primer sondeo de la utilización de instrumentos de evaluación en Uruguay, articulando con la experiencia de los sistemas de evaluación utilizados a nivel internacional basados en la evidencia y su eventual incorporación al sistema uruguayo. Metodología: se realizó a través de una encuesta difundida a nivel nacional, por medio de correo electrónico y redes sociales, dirigida a los profesionales egresados de la carrera de Psicología en universidades uruguayas, con la colaboración de instituciones públicas y privadas vinculadas al ejercicio. Resultados: Se evidencia una mayoritaria utilización de técnicas de tipo proyectivas y escasa administración de instrumentos específicos de valoración de riesgo de conducta violenta y reincidencia por los participantes. Conclusiones: se cuestiona la necesidad de revisión de los estándares de calidad científica en relación con los métodos de evaluación de las personas en conflicto con la ley en tanto se observa la ausencia de protocolos formales, accesibles y específicos que guíen los procedimientos de evaluación en el campo de la Psicología Jurídica respaldándose en la evidencia empírica.
Abstract Objective: this work presents the preliminary results of a survey conducted to psychologists to know the evaluation tools that they use in the juridical sphere in the local context. A first poll of the using of evaluation instruments in Uruguay was performed, articulating with the experience of the evaluation systems used at international level based on the evidence and its eventual incorporation to the Uruguayan system. Methodology: it was carried out through a survey released at national level, by means of email and social networks, addressed to the professionals graduated from the Psychology career in Uruguayan universities, with the collaboration of public and private institutions linked to the exercise. Results: there is evidence of a majority use of projective techniques and scarce management of specific instruments of risk assessment of the violent conduct and recidivism by the participants. Conclusions: it is questioned the need of revision of the standards of scientific quality regarding to the evaluation methods of the people in conflict with the law while it is observed the absence of formal, accessible and specific protocols that guide the procedures of evaluation in the field of the Juridical Psychology relying on empirical evidence.
Resumo Objetivo: este trabalho apresenta os resultados preliminares duma enquete realizada a psicólogos(as), para conhecer as ferramentas de avaliação que utilizam no âmbito jurídico no contexto local. Realiza-se uma primeira sondagem da utilização de instrumentos de avaliação no Uruguai, articulando com a experiência dos sistemas de avaliação utilizados a nível internacional baseados na evidência e a sua eventual incorporação ao sistema uruguaio. Metodologia: realizou-se através de uma enquete difundida a nível nacional, por meio de correio electrónico e redes sociais, dirigida aos profissionais egressos do curso de Psicologia em universidades uruguaias, com a colaboração de instituições públicas e privadas vinculadas ao exercício. Resultados: evidencia-se uma majoritária utilização de técnicas de tipo projetivas e escassa administração de instrumentos específicos de valoração de risco de conduta violenta e reincidência pelos participantes. Conclusões: questionase a necessidade de revisão dos padrões de qualidade científica em relação aos métodos de avaliação das pessoas em conflito com a lei enquanto se observa a ausência de protocolos formais, accessíveis e específicos que guiem os procedimentos de avaliação no campo da Psicologia Jurídica se respaldando na evidência empírica.
Sujet(s)
Humains , Réadaptation , Enquêtes et questionnaires , Droit pénal , MéthodologieRÉSUMÉ
Objective To analyze the relevant factors of early warning in emergency patients with high risk of acute sores, explore the application value of transcutaneous oxygen pressure(TcPO2) and transcutaneous carbon dioxide pressure(TcPCO2)monitoring in the early warning of emergency patients with pressure ulcers. Methods This was a study of 186 consecutive emergency patients who were under care in the emergency department. The transcutaneous oxygen/carbon dioxide pressure monitor was used in monitoring the oxygen saturation of the skin of sacrococcygeal region and the chest. Meanwhile,the Braden scale was used in assessing risk factors for pressure ulcers and the receiver operating characteristic curve (ROC curve) was applied to evaluate the early prediction of pressure sore with TcPO 2/TcPCO2 monitor. Results Implementing the logistic regression model with six indicators, this research concluded that TcPO2 CV and PO2 were independent risk factors for the development of Braden scale in patients with high risk. The area under the ROC curve showed that TcPO2 CV had a excellent predictive value for the high-risk group and determined its cut-off value to be 20％. Which means patient with both a value of TcPO2CV over 20％ and a high risk of Braden scale had a larger possibility of pressure ulcers. Conclusions TcPO2 CV was an independent risk factor for patients under emergency care to develop pressure ulcers. A value of TcPO2CV over 20％indicated a high risk of pressure ulcers.
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Objective To investigate the influencing factors for the psychological burden of depressive patients' caregivers. Methods We enrolled the chief caregivers of depressive patients who were hospitalized in Sir Run Run Shaw Hospital as our subjects. We investigated them by Caregiver Burden Inventory, Social Support Revalued Scale (SSRS) , Hamilton Depression Scale (HAMD) and Suicide Risk Assessment Scale, and learned influencing factors for the psychological burden of these caregivers by multiple linear regression analysis. Results We totally enrolled 101 subjects and collected 96 questionnaires (95.04%) . The 96 respondents scored (24.88±12.94) points in the psychological burden and 54 of which scored more than 20 points, accounted for 56.25%. The positive rate of mental pressure was 65.63%, which was the lowest; the positive rate of social burden was 93.75%, which was the highest. Multiple linear regression analysis showed that the objective support (β=-1.856, P=0.002), subjective support (β=0.526, P=0.008) and high suicidal score of depressive patients (β=0.290, P=0.048) were the influencing factors for the psychological burden of depressive patients' caregivers. Conclusion More than half of the caregivers have psychological burden, which is associated with objective support, subjective support and high suicidal score of depressive patients.
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To analyze the clinical features of deep venous thrombosis(DVT) in hospitalized patients and evaluate the effectiveness of Padua risk assessment model. The clinical data of DVT patients were retrospectively analyzed in Beijing Shijitan Hospital from April 1 2017 to June 30, 2017. Padua risk assessment scale was used to evaluate the risk score of DVT in the departments of internal medicine and surgery. Effectiveness of predicting DVT was analyzed by receiver operating characteristic curve (ROC). Logistic regression analysis was used to evaluate the related factors of DVT. In DVT group, age ( OR=0.96), acute infection( OR=8.23),prothrombin time( OR=0.76),D dimer(OR=1.00),erythrocyte sedimentation rate( OR=1.02) and platelet count( OR=1.01) were significantly associated with thrombosis(all P<0.05). The specificity of Padua model to predict DVT in internal medical patients was better than the sensitivity(80.7% vs. 50%,P<0.05).Surgical patients reported similar findings with specificity to sensitivity of 87.5% vs. 67.5%(P<0.05). The area under curve of ROC in internal medical patients was more than that in surgical patients[0.62 (95% CI 0.59-0.67)vs. 0.61(95% CI 0.56-0.66),P<0.05]. Padua model is more specific than sensitive to predict DVT in hospitalized patients.It has better predictive value of DVT in internal medical patients than surgical patients.
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Objective To compare the reliability and validity of 2 incontinence- associated dermatitis (IAD) risk assessment tools (IAD risk assessment scale and PAT) in patients with incontinence, and to search for the best risk assessment tool. Methods A total of 101 IAD cases were chosen from the Affiliated Hospital of Nantong University.Reliability was evaluated by the inter- rater reliability,internal consistency,item sensitivity analysis and retest reliability; validity was evaluated by the structure validity and predictive validity. Results Cronbach α was 0.313 (IAD risk assessment scale) and 0.421(PAT);Cronbach α coefficient was the highest after the items that Change sheets and mats and relevant factors were removed respectively in two tools,which were 0.431, 0.428; The correlation between the total scores were 0.711 (P<0.01)(IAD risk assessment scale)and 0.498 (PAT)(P<0.01);Area under curve were 0.661 (IAD risk assessment scale),0.864 (PAT); the best cut-off value to forecast a poor prognosis was 53.5 (IAD risk assessment scale),6.5 (PAT). Conclusions The reliability and validity of IAD risk assessment scale and PAT are low. The change of sheets and mats and Related influencing factors are needed to be adjusted and revised.
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Objective To evaluate and compare the predictive validity of the Braden Q and Braden pressure ulcer risk assessment scales in the acute pediatric patients, and explore the cutoff score of the scales. Methods We adopted the prospective cohort study design.The settings included three PICU of three different children's hospitals. Two nurses were appointed as the data collectors, and they were in charge of both the scoring and the skin assessment separately. Results We collected 145 samples. There were 9 patients who developed the pressure ulcers, and the incidence rate was 6.2%. The cutoff score of Braden Q and Braden scale was 17 and 14. The AUC of the ROC curve of the two scales was 0.481 and 0.398. Conclusions The Braden Q scale is more suitable for the pediatric patients. Further study is neededed to improve the scale.